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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004078
Report Date: 01/18/2023
Date Signed: 01/18/2023 12:22:29 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/18/2023 12:22 PM - It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:BHI-RUSH CREEK HOMEFACILITY NUMBER:
347004078
ADMINISTRATOR:THELMA ENRIQUEZFACILITY TYPE:
735
ADDRESS:9467 RUSH CREEK COURTTELEPHONE:
(916) 685-3776
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6CENSUS: 6DATE:
01/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Thelma CasugayTIME COMPLETED:
12:30 PM
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On 01/18/2022 at approximately 11 am, Licensing Program Analyst (LPA) Renee Campbell spoke with Administrator Thelma Casugay regarding the facility annual inspection. Licensee confirmed no staff or clients have experienced COVID symptoms within the last 10 days. LPA was allowed entry into the facility that is licensed to serve a total capacity of 6 clients.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature for clients is maintained at 71 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 118 degree Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. There is a minimum of 7-day nonperishables and 2-day perishables foods.

Smoke detectors and carbon monoxide were in operating condition during inspection. Fire extinguisher was last serviced on January 09, 2023. Mitigation observed to be complete and emergency relocation address with map was identified on the wall.. First aid kit was observed to be complete. Fire drill was last conducted on 01/08/2023.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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